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NHA CBCS EXAM 2024 QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS)
Which of the following Medicare policies determines if a particular item or service is covered by Medicare? Correct Answer National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? Correct Answer Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? Correct Answer Aging report Which of the following should a billing and coding specialist use to submit a claim with supporting documents? Correct Answer Claims attachment Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing? Correct Answer Claim adjustment codes On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32? Correct Answer Service facility location information A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the
billing and coding specialist take? Correct Answer Send the medical information pertaining to the dates of service requested Which of the following is the deadline for Medicare claim submission? Correct Answer 12 months from the date of service Which of the following forms does a third-party payer require for physician services? Correct Answer CMS- 1500 A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designed with power of attorney. Which of the following is considered a HIPAA violation? Correct Answer The billing and coding specialist sends the patient's records to the patient's partner. Which of the following terms refers to the difference between the billing and allowed amounts? Correct Answer Adjustment Which of the following HMO managed care services requires a referral? Correct Answer Durable medical equipment Which of the following explains why Medicare will deny a particular service or procedure? Correct Answer Advance Beneficiary Notice (ABN) Which of the following types of claims is 120 days old? Correct Answer Delinquent When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take? Correct Answer Photocopy both sides of the new card
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? Correct Answer Angioplasty Which of the following actions by a billing and coding specialist would be considered fraud? Correct Answer Billing for services not provided Which of the following statements is accurate regarding the diagnostic codes in Block 21? Correct Answer These codes must correspond to the diagnosis pointer in Block 24E Which of the following parts of the Medicare insurance program is managed by private, third-party insurance providers that have been approved by Medicare? Correct Answer Medicare Part C A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? Correct Answer Precertification **Precertification is the first step. Preauthorization is a decision from the payer to approve the service. It is not the first step to determine insurance reimbursement. Which of the following is considered fraud? Correct Answer The billing and coding specialist unbundles a code to receive higher reimbursement The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS-1500 claim form? Correct Answer Block 23 A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur? Correct
Answer The provider should contact the patient's insurance carrier to obtain a new authorization Which of the following symbols indicates a revised code? Correct Answer Triangle If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder? Correct Answer The parent whose birthdate comes first in the calendar year is the primary insurance holder Which of the following entities defines the essential elements of a comprehensive compliance program? Correct Answer Office of Inspector General (OIG) The >< symbol is used to indicate new and revised text other than which of the following? Correct Answer Procedure descriptors Which of the following describes the organization of an aging report? Correct Answer By date Which of the following is the purpose of coordination of benefits? Correct Answer Prevent multiple insurers from paying benefits covered by other policies A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? Correct Answer Clean claim Which of the following qualifies as an exception to the HIPAA Privacy Rule? Correct Answer Psychotherapy notes
copayment. Which of the following describes the insurance check amount to be posted? Correct Answer $ Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? Correct Answer Coordination of benefits If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? Correct Answer March 30 On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? Correct Answer Provider Which of the following is the maximum number of modifiers that the billing and coding specialist can report on a CMS-1500 claim form in Block 24D? Correct Answer 4 When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding specialist perform first? Correct Answer Ensure proper payment has been made Which of the following is a reason a claim would be denied? Correct Answer Incorrectly linked codes The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? Correct Answer The guidelines define items that are necessary to accurately code
Which of the following documentation is a valid authorization to release medical information to the judicial system? Correct Answer Subpoena duces tecum A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? Correct Answer Follow up with the patient to determine current name, address, and insurance carrier for resubmission A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? Correct Answer Pulmonary oncologist Which of the following is a HIPAA compliance guideline affecting electronic health records? Correct Answer The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? Correct Answer Operative report Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefits? Correct Answer Block 27 Which of the following is an example of a remark code from an explanation of benefits document? Correct Answer Contractual allowance Which of the following describes the term "crossover" as it relates to Medicare? Correct Answer When an insurance company transfers data to allow coordination of benefits of a claim
Which of the following reports is used to arrange the accounts receivable from the date of service? Correct Answer Aging report Which of the following best describes medical ethics? Correct Answer Medical standard of conduct A provider performs an examination of a patient's knee joint via small incisions and an optical device. Which of the following terms describes this procedure? Correct Answer Arthroscopy Which of the following accurately describes code symbols found in the CPT manual? Correct Answer A product pending FDA approval is indicated as a lightning-bolt symbol On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? Correct Answer The patient's condition and the provider's information Which of the following describes an insurance carrier that pays the provider who rendered services to a patient? Correct Answer Third-party payer In 1996, CMS implemented which of the following to detect inappropriate and improper codes? Correct Answer National Correct Code Initiative (NCCI) Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which of the provider has a financial interest? Correct Answer Stark Law Which of the following sections of the SOAP note indicates a patient's level of pain to a provider? Correct Answer Subjective Which of the following planes divides the body into left and right? Correct Answer Sagittal
Which of the following electronic forms is used to post payments? Correct Answer Electronic remittance advice (ERA) The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50.00 and a copayment of $20. Which of the following amounts is the patient's responsibility? Correct Answer $ Which of the following is a federal government health insurance program? Correct Answer TRICARE For non-crossover claims, the billing and coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which of the following? Correct Answer Remittance advice Which of the following actions by the billing and coding specialist prevents fraud? Correct Answer Performing periodic audits When doing a front torso burn, which of the following percentages should be coded? Correct Answer 18% Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? Correct Answer Block 24D Which of the following blocks of the CMS-1500 claim form indicates an ICD diagnosis code? Correct Answer Block 21 Which of the following national provider identifiers (NPIs) is required in Block 33a of a CMS-1500 claim form? Correct Answer Billing provider
provider's national provider identifier (NPI)? Correct Answer Block 17b When a third-party payer requests copies of patient information related to a claim, the billing and coding specialist must make sure which of the following is included in the patient's file? Correct Answer Signed release of information form A patient who has an HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain a referral? Correct Answer Primary care provider Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? Correct Answer Office of Inspector General (OIG) Which of the following is used to code diseases, injuries, impairments, and other health-related problems? Correct Answer International Classification of Diseases (ICD) Actions should be taken if an insurance company denies a service as not medically necessary? Correct Answer Appeal the decision with a provider's report The actions should be taken when a claim is billed for a level four office visit and paid at a level three? Correct Answer Submit an appeal to the carrier with the supporting documentation All dependents 10 years of age or older are required to have a military identification card for TRICARE? Correct Answer Military identification
All e-mail correspondence to a third-party payer containing patient's protected health information (PHI) should be? Correct Answer Encrypted Ambulatory surgery center, home health care, and hospice organizations use the? Correct Answer UB-04 claim form A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a? Correct Answer Patient Ledger Account What component of an explanation of benefits expedites the process of a phone appeal? Correct Answer Claim control number A coroner's autopsy is comprised of which examination? Correct Answer Gross examination What do physician's used to electronically submit claims? Correct Answer Clearinghouse A form that contains charges, DOS, CPT codes, ICD- 10 - CM, fees, and copayment information is a? Correct Answer Encounter form The function of the respiratory system? Correct Answer Oxygenating blood cells What medical term refers to the sac that enclosed the heart? Correct Answer Pericardium Medigap coverage is offered to Medicare beneficiaries by? Correct Answer Private third-party payers
A physician ordered a comprehensive metabolic panel for a 70- year-old patient who has Medicare as her primary insurance. This form is required so the patient knows she may be responsible for payment? Correct Answer Advance Beneficiary Notice A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? Correct Answer Adjustment column of the credits Sections of the medical record used to determine the correct Evaluation and Management code used for billing and coding? Correct Answer History and Physical The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? Correct Answer Reinstate or recycled code This block requires the patient's authorization to release medical information to process a claim? Correct Answer Block 12 This describes an obstruction of the urethra? Correct Answer Urethratresia This includes procedures and best practices for correct coding? Correct Answer Coding Compliance Plan This indicates a claim should be submitted on paper instead of electronically? Correct Answer The claim requires an attachment This privacy measure ensures protected health information (PHI). Correct Answer Using data encryption software on office workstations
This provision ensures that an insured's benefits from all insurance companies does not exceed 100% of allowable medical expenses? Correct Answer Coordination of benefits This statement is true regarding the release of patient records? Correct Answer Patient access to psychotherapy notes may be restricted Verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? Correct Answer Consent agreement What actions should be taken first when reviewing a delinquent claim? Correct Answer Verify the age of the account What actions should the billing and coding specialist take if he observes a colleague in an unethical situation? Correct Answer Report the incident to a supervisor What claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? Correct Answer Paper claim What color formats is acceptable on the CMS-1500 claim form? Correct Answer RED What department should a patient be seen for psoriasis? Correct Answer Dermatology What form should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? Correct Answer UB- 04 What information is required on a patient account record? Correct Answer Name and address of guarantor
After a third-party payer validates a claim, which of the following takes place next? Correct Answer Claim adjudication A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? Correct Answer 0% A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? Correct Answer Precertification A billing and coding specialist has four past do payments, which one goes to collections first? Correct Answer The largest past-due charge A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits box has been checked yes. The checked box indicates which of the following? Correct Answer The provider receives payment directly from the payer Block 17b on the CMS-1500 claim form Correct Answer referring physicians NPI A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. Which of the following should the specialist refer? Correct Answer Remittance Advice A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial? Correct Answer The claim will not be resubmitted and the patient will be sent a bill
The destruction of lesions using cryosurgery would use which of the following treatments? Correct Answer Cold treatment For non-crossover claims, the billing & coding specialist should prepare an additional claim for the secondary payer & send it with a copy of which of the following? Correct Answer Remittance advice If a patient came in for an office visit and had an EM, what would be the first diagnosis? Correct Answer inpatient-principle diagnosis, outpatient-primary diagnosis The EOB states the amount billing was $80. The allowed amount is $60, and the patient is requires to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? Correct Answer $ In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were medically necessary? Correct Answer CMS The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. Which of the following amounts is the patients responsibility? Correct Answer $ NPI for referring provider is in block Correct Answer 17b On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into block 32? Correct Answer Service facility location information A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following
